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EDITORIAL: Senate health care bill shows GOP has lost its way

San Diego Union-Tribune (CA)

June 23--A case can be made that the Senate Republicans' bill to replace the troubled Affordable Care Act is better than the House Republicans'. But its two giant flaws -- denying ready access to health insurance for millions of people and providing nearly $1 trillion in long-term tax cuts to the wealthy and to corporations -- overwhelm arguments in its favor.

Yes, as conservative health-care expert Avik Roy argues, it insulates the elderly poor from devastation by keeping Obamacare's income-based subsidies for health insurance purchased on the federal exchange instead of the age-based subsidies House Speaker Paul Ryan wanted. Yes, those with pre-existing conditions could obtain insurance more easily -- although with policies that may not protect against huge medical bills and with none of Obamacare's certainty. And yes, it creates strong cost incentives for governors to make sure Medicaid actually improves health-care outcomes -- a great idea considering the contrary evidence from a study of more than 20,000 Medicaid patients in Oregon.

But a timely New England Journal of Medicine analysis published Wednesday lays out the downside of returning to the pre-Affordable Care Act era of societal callousness about poor and middle-income Americans who can't afford health insurance. The study cites compelling evidence that providing access to health care improves a wide range of health outcomes, reduces deaths and is cost-effective compared to federal laws providing workplace safety and environmental protections.

While the Senate bill may not cause 23 million people to lose their health insurance -- as was forecast for the House bill -- nearly as many seem likely to lose coverage, because the Obamacare expansion of Medicaid eligibility would be reversed and because of affordability. Under the Senate plan, for example, people in their 50s would face premiums of more than $1,000 a month on the federal exchange -- up 13 percent from today. Republicans haven't solved their conundrum: The uproar over how the Affordable Care Act's mandates made health insurance so expensive has driven the GOP's nationwide success since 2010, but the party's proposed fixes offer little or no relief to many Americans.

Which brings us to the most perverse part of this policy fight: Far and away the biggest beneficiary of the Senate bill -- much more so than young people whose premiums would drop in cost -- are the very wealthy. About 40 percent of the bill's $992 billion in tax cuts -- achieved by reversing Obamacare tax hikes -- goes to those in the top 1 percent of income. Only in the modern Republican Party could what passes for health care reform include a massive tax cut for millionaires and billionaires.

A recent Democracy Fund Voter Study Group analysis found that millions of disaffected populist voters -- people who think the system is rigged against the little guy -- helped Trump become president. The same analysis showed that Trump voters strongly support preserving the social safety net. It's almost inconceivable that Trump's first big policy victory could hammer the little guy, batter the middle class and most help those who don't need help. If that happens, the president and the GOP will have defined themselves in damning fashion.